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A conservative defense of the individual mandate

Post by TNT Editorial Board / The News Tribune on July 2, 2011 at 3:38 pm with 11 Comments »
July 1, 2011 5:41 pm

This editorial will appear in Sunday’s print edition.

Legally, the soft underbelly of “Obamacare” is its mandate that most Americans carry health care insurance. It got some much-needed armor last week from a federal appeals court.

Conservatives – who are otherwise big on personal responsibility – have locked onto that requirement as the most vulnerable target in the Affordable Care Act, which promises to extend health coverage to millions of uninsured Americans in 2014.

Trial judges aren’t supposed to decide cases on ideological grounds, but you’d never know it from the lawsuits against the individual mandate. According to Politico, the court decisions have split cleanly along partisan lines: Judges appointed by Republicans have all ruled against the law, and judges appointed by Democrats have all ruled for it.

That curious string of coincidences finally broke Wednesday when a respected conservative jurist – and former clerk to Supreme Court Justice Antonin Scalia – upheld the constitutionality of the maligned policy. Jeffrey Sutton of the Sixth U.S. Circuit Court of Appeals provided the pivotal vote in favor of the mandate in its first test at the appeals level.

Opponents of the law make a serious argument: If Congress has the power to force citizens to buy a private product (health insurance), what can’t it force them to do? Can it order them to eat spinach, join the YMCA or take vitamins for the sake of their health?

But Sutton points to the uniqueness of health insurance: “Regulating how citizens pay for what they already receive (health care), never quite know when they will need, and in the case of severe illnesses or emergencies generally will not be able to afford, has few (if any) parallels in modern life. Not every intrusive law is an unconstitutionally intrusive law.”

That’s the core issue. The Commerce Clause allows Congress to regulate the marketplace of health care, and virtually everyone is in that marketplace by virtue of the fact that they will get seriously sick and they will get at least some care when they get seriously sick.

The individual mandate helps ensure that irresponsible people don’t rip off their fellow citizens when they wind up in the hospital or emergency room.

Health care providers are unlike other merchants: Many of them are required by law to treat sick people whether they pay for that treatment or not. Citizens who can afford insurance but don’t buy it – free riders – stick it to the rest of us when they rack up a $10,000 or $20,000 medical bill they can’t afford. When they don’t pay, responsible Americans wind up swallowing the bill through cost shifts.

Just like mandatory car insurance, this is all about personal responsibility. We don’t see too many of the free riders pledging not to use the emergency room or MRIs or cancer surgery when they need them. Hence they are in the market. The individual mandate simply prevents them from walking out the door with unpaid merchandise.

Leave a comment Comments → 11
  1. It’s not even a conservative defense. It’s a conservative idea. It came out of a Republican proposal in the 90’s designed to preserve our private market system.

  2. melbawatson says:

    It got some much-needed armor last week from a federal appeals court.The federal government is lowering premiums for a taxpayer-subsidized plan that provides health insurance for those with pre-existing conditions check “Penny Health” website

  3. If the Feds decree every grocery purchase must include at least a pound of vegetables and a pound of fruit, are you OK with that too? Proper diet is all about personal responsibility but look around, most Americans are eating poorly and that has a huge impact on cost of healthcare borne by all. So Obama and the rest of the Nanny State need to get in there and MANDATE those healthy purchases, and Y memberships (and regular attendance too!) because the Tribune and too many citizens have lost sight of the core concepts of personal responsibility and freedom. Happy 4th of July!

  4. NWflyfisher says:

    Deciding to use an umbrella in the rain is your personal choice. Being told by the government you must use an umbrella in the rain or pay a penalty takes away your personal choice and amounts to a tyrannical denial of your freedom – a good reminder for this Independence Day in my opinion.

  5. I think some are missing the point. The mandate is there because it’s not just an individual choice. At some point you will get sick or injured and require medical attention. Those bills go unpaid and are then absorbed by those of us who buy medical insurance. You’re not defending liberty, you’re defending freeloading and the private system simply will not be able to exist unless something like this is done. The only other option is a single-payer system which I’m guessing conservatives would hate even more. Or I guess we could just start turning people away from ERs… but that seems rather unlikely.

  6. Freeloading? The poor will be with us always. There are ways to provide them care, including government programs. Forcing citizens to purchase a product by tying it to health care is a HUGE expansion of federal control. You are missing the point.

  7. The individually self-unidentified editorial”team” slips in –

    “Citizens who can afford insurance but don’t buy it – free riders – stick it to the rest of us when they rack up a $10,000 or $20,000 medical bill they can’t afford. When they don’t pay, responsible Americans wind up swallowing the bill through cost shifts.”

    I noticed the term “citizen” in this paragraph…….that of course includes anchor babies….and the parents? ( shhhh, that’s politically incorrect to notice details like that, right?)

    So who is getting all those waivers, anonymous editorial staff?
    Friends of Obama or “FOO”?

  8. Paper, I’m not just talking about the poor. If you “choose” to not buy health insurance you are inherently using other people’s money because eventually you will require health care from a system you have not paid into. There is nothing conservative about such a system.

  9. I don’t care about labels. You & the Tribune are into Conservative v. lib, apparently, not me. I care about liberty and keeping the govt, especially the Feds, out of the few areas they haven’t yet encroached. You are so worried about some folks getting what they haven’t paid for -which you say they already get anyway at the ER – that you are willing to grant the federal government authority to dictate citizens purchase products – an intrusion into private life without precedent. We need to reign in government, not find excuses to expand it.

  10. What about people who have low paying jobs that cannot afford the high cost of health care? When people are making 18k-25k a year and the health insurance premiums that companies want you to pay are higher than a kit, then what are people to do? Not pay the electric bill or gas bill or put gas into the tank to get to work? Canada has socialized medical and it seems to be working for them. I put it this way, I do not read about any debates in Canada about wanting USA health care. If they can do it, so can we. BTW..I am one of the freeloaders who do not have health insurance because I cannot afford it with the salary I make. I had health insurance for years but when it comes to feeding my family and putting a roof over their head than having health insurance but no lights and gas seems to be somewhat of a predicament for me.

  11. NWflyfisher says:

    Gary: From the Tacoma-Pierce County Health Department ( “Many families who have lived without health insurance will now have free or low-cost insurance available. Kids and pregnant women are considered for free health insurance first. Kids who don’t qualify for free insurance are screened for low-cost health insurance. Kids who don’t qualify for free insurance may be eligible for low-cost coverage. Coverage can be as low as $20 per month, per child with a maximum of $60 per month, per family”.

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